Episode 19: Sunday October 25

Drs. Sam Jejurikar, Salvatore Pacella, and Sam Rhee welcome special guest Dr. Paul Cederna, M.D. Dr. Cederna is the Chief of the Section of Plastic Surgery at the University of Michigan. A leader in academic plastic surgery. Dr. Cederna has been the Chairman of the American Board of Plastic Surgery, Chairman of the Plastic Surgery Research Council, President of the American Society for Peripheral Nerve, President of the Michigan Academy of Plastic Surgeons, and President for the Plastic Surgery Foundation.

How does a leader of one of the country's top academic plastic surgery programs manage responsibilities and accomplish goals? What research interests continue to drive a leader to push forward? What are the biggest challenges facing a leader when they work to achieve success? We ask Dr. Cederna all these questions and more. Do not miss! Let's go Blue!

Full transcript (download PDF here)
Dr. Sam Rhee: [00:00:00] Welcome to another episode of Three Plastic Surgeons and a Microphone starring as always Dr. Sam Jejurikar from Dallas, Texas, Instagram handle @samjejurikar. Dr. Sal Pacella from LA Jolla, California. His Instagram handle is @SanDiegoplasticsurgeon,  and I'm Sam Rhee from Paramus New Jersey. My Instagram handle as always is @Bergencosmetic.
You can get all our episodes at www.3PlasticSurgeryPodcast.com 
As always our disclaimer, this show is not a substitute for professional medical advice, diagnosis or treatment. This show is for informational purposes, only treatment and results may vary based on circumstances, situation, and medical judgment after appropriate discussion.
Always seek the advice of your surgeon or other qualified health provider with any questions you may have regarding medical care and never disregard professional medical advice or delay seeking advice because of something in this show. And with that, I'll turn it over to Dr. Pacella. How are you? 
Dr. Salvatore Pacella: [00:00:57] Very good gentlemen.
Welcome. How are you guys? 
Dr. Sam Jejurikar: [00:01:02] Doing great. Doing great. 
Dr. Salvatore Pacella: [00:01:04] Awesome. as you could see her, we've got a little bit of a theme here. Everybody's got a little bit amazing and blue on, so let's, let's just see, I got my, Or is it my Michigan rugby gear on left a lot of blood in Ann Arbor, years ago.
we have a special theme of this show going on, talking about our time at Michigan and we have a very special guest we'd like to bring on. I wanted to introduce our former or our, former professor and current chairman at the University of Michigan, Dr. Paul Cederna. And Paul is the Robert O'Neill professor of plastic surgery and the chief of the section of plastic surgery  at the university of Michigan, he specializes in complex wounds. He's an incredible surgeon. he combines, an incredible expertise in general surgery, microsurgery and plastic surgery, and also has a very, productive lab in the, yeah, the division of biomedical engineering at the university.
Paul received his bachelor's of science in biomedical engineering at the university of Michigan college of engineering and his MD. MD degree from the university of Michigan medical school. he completed general surgery and a fellowship in microsurgery at the university of Iowa. And then came back to Michigan, where he completed his plastic surgery training.
He then completed two additional years in the Muscle mechanics laboratory at the university of Michigan. Paul is, just a tremendous giant academically. He's had a very active research enterprise directing the neuromuscular research laboratory at the university of Michigan. he's received over $29 million in direct research funding has authored over 350 scientific manuscripts and publish 27 book chapters presenting his work over 800 times in national and international meetings and has been asked to give over 400 presentations.
professionally he's been the chairman of the American board of plastic surgery. That's the main board that's responsible for board certification for, all plastic surgeons. He's been the chairman of the plastic surgery research council, the president of the American society for peripheral nerve surgery.
He's the, he's been a former president of the Michigan Academy of plastic surgery and president for the plastic surgery foundation. There is, the only thing that's bigger than, and Dr. Cederna's  CV are the rims on his, SUV.
Dr. Paul Cederna: [00:03:22] That introduction just tells me I like work too much.
Dr. Salvatore Pacella: [00:03:25] You're welcome. It's it's been fantastic to connect with you. We've, we've been, friends and colleagues over many years and, we really appreciate you taking the time to come on and chat with us about, everything you do at the university and w we'll reminisce a little bit about our time there.
these two jokers I'm with here can certainly recall many stories with you and us. And, it's just been an honor to, to get to know you as a teacher, professor and colleagues. 
Dr. Paul Cederna: [00:03:49] Yeah, thanks guys. I gotta tell you, I love seeing the Michigan swag. It looks so good. At least we just crushed him in the resident bowl at ASPS so far when at least our. Are like plastic surgeons dominated them. So that's good. 
Dr. Salvatore Pacella: [00:04:05] so Paul, tell us a little bit about your life as chairman there. what do you, do with, teaching with the residents? what's your average week? how is it structured? 
Dr. Paul Cederna: [00:04:15] Yeah, so thanks. since all of us trained in plastic surgery at Michigan, we're a really different place now. So we have 19 full time plastic surgeons just at university of Michigan hospital. And these are people that don't have private practices or side jobs or anything.
They're all just right here. So it's a big place. You've got 28 residents. So lots of residents, we did over 4,000 major operations last year. 30,000 clinic visits, it's just a busy place. So as you might imagine, in my role of keeping all the faculty happy, keeping all the residents, happy, keeping all the business flowing forward.
it's just a lot of different things. Every single week, lots and lots of meetings, lots of managing people's. Issues. It's always HR lots and lots of HR issues, but I got to tell you, we have such a great group and I absolutely love it. So for me anyway, in this job, I love operating, so I still operate two days a week.
So my favorite days of the week by far love operating love, spending that time in the, or love being with the residents. It's just relaxing. There's nothing else to do, but just operate, teach. And enjoy the day. And then I haven't, I know I have a day, a week in clinic where I just see it ton of patients for a full day and then two days of paperwork, which are the days that are the least fun of all of them.
And I think everyone would agree base of paperwork are probably the thing that is the least fun for everyone. But, I'm really proud of the place we have. We have this incredible collection of faculty members. We have such a gifted group of trainees. Oh my God. They're so smart. it's really impressive.
I love it. 
Dr. Salvatore Pacella: [00:05:58] there are many exciting things happening at the university of Michigan when I left there in 2007, I recall that there were about four new brand new buildings coming up, or that were being built in 2007, even including a brand new children's hospital. and then when I came back in 2014 as a visiting professor, at your invitation. all four of those buildings had been built and they were putting up five more buildings. 
it's just the endowment of Michigan is incredible. So tell us a little bit about what's happening there now. what's going up on campus. what's the exciting stuff around town. 
Dr. Paul Cederna: [00:06:34] Yeah. the, I think to see the vitality of a university, all you have to do is walk onto the campus and you've seen it. There's a lot of building going on. that place is really growing and developing and evolving and changing. And so there are. Many building projects going all the time.
we are just getting ready to get back to constructing our new surgical tower, which we're all really excited about. It's going to be next to the current facilities that we have and it's gonna be yeah. Brand new tower just for surgery. Huge tower 12 stories, a maker. So we're all really excited about that, but we just finished building a new multidisciplinary outpatient center, which is also incredibly impressive.
and it's got, a bunch of operating rooms in a bunch of clinics. It's massive and beautiful. It just, it's so exciting to be in such a vibrant community. That's doing so well, and we're immune to a lot of the. Issues around the economy. Cause the university just creates its own economy here in Ann Arbor.
And that's what Ann Arbor is the university of Michigan. Yeah. So it's nice. 
Dr. Sam Jejurikar: [00:07:40] So in addition to having a large faculty, you have an incredible collection of faculty members as well, some really internationally respected. What is it about the, about the university of Michigan that's able to attract so many great and amazing plastic surgeons, both as faculty and residents.
Dr. Paul Cederna: [00:07:57] Yeah. so thanks Sam. the biggest thing about it, I think more than anything is no, we are fully committed to the tripartite missions of academic surgery, of teaching. Research and clinical care and people actually are given time for their research. So what does that mean? That means that everybody here has two full days, a week to do research in whatever it is that they want to do research.
And so Christian Vercler is one of our craniofacial surgeons. He has two graduate degrees in ethics. His research is in ethics. Steve Kasten has a graduate degree in education. His research is in education. We have Jen Waljee runs this huge group of health services researcher. Her research is in opioid, and we have basic scientists.
We have all these other things, but if people are given that time to get the research done, They can get things done. And when they do, then they publish papers, they get grants, they traveled the world giving talks and they actually experienced the benefits of academia. otherwise it's really not that dissimilar to, if you're just going to be a busy clinician operating five days a week, you can do that.
Anywhere, you may not exactly have the job you want anywhere, but when people come here, they get something they can't get anywhere else. And that is the time to do the things that they really love. The time to do the things they're passionate about the time that they can create something, innovate something, develop something that changes the specialty change that the care of patients changes the way we do things going forward.
And that being at the tip of the spear. Best place to be for sure. Never want to follow. I'll always want to lead and just gives people a chance to do that. So when they get dialed in here, Perfect because they have that time 
Dr. Salvatore Pacella: [00:09:43] now. now obviously with, when we were all residents there, we understood what Michigan meant  the university of Michigan meant to the state of Michigan and the region. but for our listeners out here, tell us a little bit about what the university of Michigan health, just a means to the general community in the Midwest. what value does it provide for the entire state? where do you guys fit into the healthcare of the state of Michigan and the Midwest in general?
Dr. Paul Cederna: [00:10:13] Yeah. so the university of Michigan is a big university and university of Michigan health system is a really big place. I think we have somewhere in the range of maybe 1,100 beds on campus here, something like that, 1,200 beds, a lot of beds. And then it's a big, busy place. The thing is that it's the only big university hospital in the state.
And in the Midwest, there are a few that are around that are really good. There aren't that many places where you can take care of. Both the common things that you see in your local communities and everything, but then the incredibly difficult things. And when you're coming from a place like this, where the person who invented ECMO is one of your faculty members, now all of a sudden you have all these things.
sick patients coming in to get that kind of care. And most of us love being in a place that has opportunity to provide care to the sickest of people out there. And there just aren't that many available for that, which means then that, although we're in a small community, Of 110,000 people. We have a campus with 35,000 students.
We have a hospital with 20,000 employees and we have the sickest of sick patients in the entire region, which is really an incredible opportunity for us. So university of Michigan is plays a very prominent role in all of that. And I love the fact that we can actually be that go to place where the really hard things happening in.
Nobody takes care of them. For instance, last week I did this case, just a quick case. This was, it was amazing and very unfortunate guy, but he had a massive circle. Then his chest wall and the thoracic surgeon cut a 45 centimeter hole through and through his chest wall, diaphragm, abdominal wall, he needed this massive reconstruction and no one would touch this guy anywhere.
And we're like, sounds great. Let's take care of them. Let's fix him. Love that. It's 
Dr. Salvatore Pacella: [00:12:11] amazing. yeah, go ahead. Sameer. 
Dr. Sam Jejurikar: [00:12:15] Say, the thing that's always struck me as different about you compared to other academic chairman is a lot of academic chairman reached this point where they're doing largely administrative stuff, and they're still on having that passion 
for research or for surgery. And you still have both quite a bit. And what's, I've always loved about you, is your modesty. You have an incredible faculty that is underneath you, but you're doing some pretty incredible things yourself. and it'd be awesome. If you could share with our viewers, some of the exciting things you're doing in your own lab, 
Dr. Salvatore Pacella: [00:12:41] that would be a great segue.
Dr. Paul Cederna: [00:12:44] Oh, yeah. Thanks. Thanks a lot for that. I gotta tell you one of my, one of my athletic. Heroes is this guy, Steve Yzerman, who is the captain of the red wings. He buys him. And wasn't one of these guys that got up and, to his own horn or made a big deal about anything he was accomplishing.
He was there for, he was the first one there to the rink. Every day, they play a game. He'd be back on the bike training for an hour and a half after the game. So he's the fittest. He had worked the hardest and he just was a servant leader. And I like to think of myself the same way. it's really hard for me to tell people to do things if I'm not in the trenches with them.
it's re all of that is really important to me, but anyway, okay. let me, can I show some five fun? absolutely cool stuff. Okay. Here we go. let me bring this up here. Okay, can you see my slides? Okay. Perfectly. Alright, awesome. So I got to tell you, so there was this a TV show in 1973 to $6 million man.
And this show was awesome. And this guy, Steve Austin. he, crashed a plane and he lost both his legs and arm and an eye, and they decided to rebuild him with bionic parts. And I'm going to just play the trailer for the show for you. This is great.
so that I couldn't tell you that show was awesome. that's 1973 that, that's almost 15 years ago. That is an old show. But, when we're still trying to get there. And now, with inflation, it was the $6 million man, but we're really closer to 6 billion now. Okay. I got it.
But, there's tons of amputations in North America alone. They're like 3 million people living with limb loss. So it's a huge problem. And you've, we think of what the prosthetics were like back in the civil war era. They look like this, and then the sixties, they look like this, and now they actually look basically the same and they're run by cables and rubber bands and we really haven't made any progress.
So it's pretty depressing. So yeah. What did people have actually tried to control prosthetics? So in the brain, has all the signals in it to control things. So there's an area in the brain that controls the hand. So people have actually put probes into the brain to pick up signals in the brain to control a prosthetic device.
So I'll show you this video of somebody doing it. This woman here actually is using a probe in her brain to control this arm, to bring this water bottle to her mouth. And it's actually pretty amazing that Jess with her brain she's able to do that. the problem is if somebody is young and they lose an arm, it's probably isn't good enough control.
And so we really need to do better. And so we started doing research in this area, really looking at the peripheral nerves. So instead of going to the brain will send those signals down the peripheral nerves. And then if we can pick the signals up from the peripheral nerves, We could control a prosthetic, but control it in a better way.
So the way that we decided to do this is you can disect a nerve into different branches. And then if we put little pieces of muscle on the end of each of those nerve branches, then when a nerve signal comes down, this tiny little nerve signal comes down. We can amplify it with that piece of muscle. We can pick up the signal and then feed that to the prosthesis and get the prosthesis to move.
And so here you can see one of these little. They're called and I's in the red box there in the wire coming down into it. And you can actually see how much the, that piece of muscle amplifies these nerve signals. Here's the tiny little noise and here's a signal. So it really works well. And so then if we implant electrodes into the nerve, the way it would work, cause your brain would say, move them the signals down your nerve.
It, the signals would get amplified by that piece of it. Muscle, the electrical load, pick up that signal. And then we could feed it to the prosthesis and get it to move. So I'll just show you this right here. So this white hand in the front is telling our patient what to do, and this is what he's doing with his computer avatar hand in the back.
And it's green when he gets it right. And it's red when he gets it wrong. But you can see extending thumb, flexing, index, finger flexing, thumb, flex wrist. Spread fingers. So he already has more control over his computer avatar hand, then prosthetic hands can even do, which is really exciting for us because it tells us actually that we have the ability to give people function back.
That's better than the function they have. 
Dr. Salvatore Pacella: [00:17:17] Hey, Paul, can we just go back one slide here? Just that's it just wanted to be clear about something. to the, where you had the green avatar hands. So this, this decoding hand that's directly from the patient's brain, 
Dr. Paul Cederna: [00:17:31] correct? Yes. Okay. And there was no, this is the very first time he tried to control this computer avatar hand.
No training, no anything. That's just his brain, but it always did when you had a hand. 
Dr. Salvatore Pacella: [00:17:44] So for our viewers out there, this is groundbreaking stuff here. These are electrodes in your brain and you think I'm going to move my right thumb. And it shows up on the avatar on the, green side, correct?
Yup. 
Dr. Paul Cederna: [00:17:59] Yup. Yup. so then we take this, so this prosthesis right here. Wait a second. I'll show you this one right here. So he's controlling this hand. This is one of the most advanced hands out there. it takes four different electrodes or different signals to be able to control this thumb. And all he's doing is he's imitating Phil's hand is just moving his normal hand and he's moving his prosthetic thumb.
Dr. Salvatore Pacella: [00:18:27] This is from his brain. This is from his brain. 
Dr. Paul Cederna: [00:18:29] the brain thing was coming down and we're picking them up off his RP and eyes on his peripheral nerves. Yup. Wow. Yup. So then you watch here, we're asking them to just turn a key and watch he'll just turn a key, like thumb and index finger, just like you, or I would turn a key with this prosthetic hand.
So no, one's actually been able to ever demonstrate anything like this before, so it's pretty sweet. And then your watch. The interesting thing about this is the interesting thing about this one right here is if you watch here, these three fingers move as a single unit, this prosthetic, even though it's one of the most advanced prosthetics, these fingers don't move independently.
They only move as a single unit, but you can watch how quickly he can just move these just by thinking about it.
Dr. Salvatore Pacella: [00:19:16] That's unbelievable. 
Dr. Paul Cederna: [00:19:17] That's actually really cool. Yeah, it's really cool. And then you watch here. He can move his thumb and index finger around. So the thumb gives like 40% of the function of the hand. So if you can position that thumb in space, you can do almost anything. And then this is another one of our patients.
She has a different prosthesis cause she's, got smaller arms. So this one, but you'll watch her and she's gonna move each of these fingers individually so she can has control over all five fingers.
So the thing that's cool about this, you do see that the hand moves slower. His hand isn't as fast. So there's never been a good way to control these prosthetics. So there's never been a reason for the prosthetics companies to make really good ones. but now that we have this way to control them, this is a great opportunity to, for them to now start making better prosthetics that move faster, that move more naturalistically.
So now I want to talk about providing sensory feedback. So the way this works now is if we have a prosthesis that has sensory devices on the fingertips, the prosthesis can create an electrical signal. When they grab something, we can take that electrical signal and we can stimulate the end of their nerves in a certain way.
And we can give them sensation back to their fingers. So what I'm going to show you is here, this setup. She's sitting here. We have an object here to large can and she is mimicking with her left, intact hand, just motion, but she's moving her avatar right-hand and we're stimulating the nerves that go to her right hand that isn't there to give her a sensation of what might be in her hand.
You got that. 
Dr. Sam Jejurikar: [00:21:08] I think so
Dr. Paul Cederna: [00:21:09] she is going to, with her avatar hand that a hand, she doesn't have her Phantom hand. She is going to grab this object. Okay. And we are going to give her sensory feedback to give her a sense of how big that object is and how hard it is. So she isn't feeling anything other than the sensory feedback we're giving her.
Dr. Salvatore Pacella: [00:21:33] Okay. does she know what the object is when she's grabbing it? 
Dr. Paul Cederna: [00:21:36] Folded she's blindfolded and she has headphones on, so she can't hear anything. Okay. 
Dr. Salvatore Pacella: [00:21:41] So she doesn't know what that it's a, can, she doesn't know it's a key. She doesn't know it's a bad. 
Dr. Paul Cederna: [00:21:47] And then we're stimulating all the nerves to all her fingers in the hand that isn't there.
Yeah. Yeah. Okay. Okay.
Dr. Sam Jejurikar: [00:21:56] Evolves. 
Dr. Paul Cederna: [00:21:58] Cause it's squishy. And so he can stimulate it in a certain way. So she knows it's small and it's squishy. So her avatar hand closes a lot until she feels that. And then it isn't a real hard stop. And we can do that with how we stimulate the nerves in her missing hand. 
Dr. Salvatore Pacella: [00:22:14] So you're 
Dr. Paul Cederna: [00:22:15] yeah. 
Dr. Salvatore Pacella: [00:22:16] So 
Dr. Paul Cederna: [00:22:17] you're creating 
Dr. Salvatore Pacella: [00:22:18] these signals, correct? 
Dr. Paul Cederna: [00:22:21] Yup. We have programmed. How hard or soft it is? We programmed how big or small it is. So when she starts closing her computer avatar hand, if it's a big object, we will immediately start stimulating her sensory nerves. Cause our fingers are starting to touch it.
And then if she closes her. Virtual hand even more. We'll see emulate a lot. If it's a hard object, she knows she can't move her fingers any further in her avatar hand. But what this is demonstrating the reason we're doing it in this way. None of the prosthetics have good enough sensory feedback on them that we could do this with them, prosthetic Canterbury.
So we've already gone way past what the prosthetics in the world can do. 
Dr. Salvatore Pacella: [00:23:07] Amazing. 
Dr. Paul Cederna: [00:23:08] That is amazing. Yeah. So here you watch this one. I like this one. 
Dr. Sam Jejurikar: [00:23:13] Yes. Since it is harder. Yeah.
Dr. Paul Cederna: [00:23:16] Some more squeezable thing. She got stuffed animal. And then here with this one she's blindfolded and she has headphones on because we don't want her to be able to hear the motors of the hand moving so she can figure out how big or small something is just based on how long the motors are running. So really testing if our sensory feedback is good,
Dr. Sam Jejurikar: [00:23:38] Wow.
Dr. Paul Cederna: [00:23:39] Yeah. This stuff is super cool. 
Dr. Salvatore Pacella: [00:23:47] So the value of the sensory motor feedback is that the patients feel like it's their own hand. It's not just some stranger's hand. 
Dr. Paul Cederna: [00:23:55] Yup. Yup. And, and the thing that's interesting about it is a prestige. You don't want to prosthesis like a tool, like you pick up a hammer and you've got a hammer in your hand.
It's just like a tool. What we want is it's called embodiment. We want that thing to become part of their body. And if you can give them sensation back now, it's actually, now that they can move it like a hand and it has sensation now it's like part of them. Yeah, so that stuff is really fun to read.
Wow. 
Dr. Salvatore Pacella: [00:24:26] so Paul, this is, for our viewers out here that this is absolutely groundbreaking research and it's right here in your backyard. And the interesting thing about it is when I was a resident and when these guys were residents, we talked about this a little bit. It wasn't really, on our radar, this isn't a whole nother group of the plastic surgery division at the university of Michigan.
So it just Talks about your modesty as a leader, this is absolutely groundbreaking stuff that you're doing here. Are we didn't really hear much about it back then, 
Dr. Paul Cederna: [00:24:57] Yeah. 
Dr. Sam Rhee: [00:24:59] I'm sure everyone who sees this type of work that you're doing must ask. Okay. So when can I get this?
For myself or my, 
Dr. Paul Cederna: [00:25:07] yes. So my patients we're working through, we've implanted now two different patients. We're in a, what's called the FDA IDE clinical trial. So the FDA is really monitoring every single person really carefully to make sure it's safe to make sure that there's no problems with anything.
and, we just keep. Implanting people. We have another one. Yeah. Coming up here soon. And one shortly after that, and we're doing all this monitoring and then we keep going back to the FDA saying, okay, when are we done? When are we done? When can we make this available? the nice thing about it is the actual surgery itself could be accomplished by any hand surgeon in the world.
So it isn't it's something so challenging that people can't get it done, which means then it's scalable to the world. and if we can start doing all the work around showing how well they're doing functionally and satisfaction, measures and return to work and all these things, now, all of a sudden we can actually make a really good argument for insurance companies to cover this.
And then when insurance companies cover it, yes. now it's available. 
Dr. Salvatore Pacella: [00:26:14] So Paul, what, I see this and I see the amount of money that this might take to develop in the amount of, CA resources to follow this. Why wouldn't a patient just want a transplant hand from a cadaver.
What, tell me. Tell me what your thoughts are. why go the mechanical route? Why not just transplant a hand? 
Dr. Paul Cederna: [00:26:34] Yeah. So the great, that is a great question. That's a question we talk about all the time. So the biggest challenge with transplant hands are people need to take immunosuppression and they need to take a lot of immunosuppression.
And when they take that immunosuppression, bad things happen, they get, they can get. Liver toxicity, kidney toxicity, heart toxicity. They can get bad infections. They otherwise wouldn't get, they can get cancers and people actually die from it. And so if you're replacing, I understand if somebody needs a new heart and they can't survive without a heart, they need a heart transplant.
And then all those other things just come along with it. But if somebody can get by without a hand, Or there's other substitutes and they don't have to take all that immunosuppression and it's then it's fine. The other thing is if you have an amputation up high in your arm, the nerves that grow back to that transplant takes so long to grow back that by the time they get there and nothing works that well.
So the hands don't work very well. so I got to tell you, I want the transplant surgeons to keep working on that. I want, if they can make the immunosuppression better, there might be really good opportunities for transplanting transplant, a single finger, maybe transplant a year, transplant and nose.
If immunosuppression doesn't hurt people, but at least for now, the control we get with the prosthetic hand is really good. And it's so safe. 
Dr. Sam Rhee: [00:28:06] Paul, how large is your group and who's funding you guys? 
Dr. Paul Cederna: [00:28:09] so a majority of the funding that we've gotten is been from DARPA and the department of defense. So DARPA is a group through the department of defense that funds all this high risk, high yield research.
So I love DARPA. So DARPA will have a project, then they will fund 25. But then they will just keep cutting people. If they're not making progress until they get to the end. You might only be funding three or four at the end of the whole grant period. But you know what? I love working that way. I'll work that way all day long.
If I tell you I don't do it, take my money. You shouldn't.
Dr. Sam Rhee: [00:28:46] Inner the internet was founded in part by DARPA research, 
Dr. Paul Cederna: [00:28:50] satellite internet, all that stuff, underwater, welding, all that stuff is DARPA. Yeah. And then the department of defense has funded a lot. That is funded. It's done. And actually our group in the plastics in plastic surgery foundation has funded part of the work and the foundation for the American surgery.
The hand is gone, has funded it. 
Dr. Sam Jejurikar: [00:29:12] And, and how many people are part of this team that are developing this. Cause it seemed like you would need hundreds of people to be working. 
Dr. Paul Cederna: [00:29:18] Yeah. So our team right now with the, my lab has about 14 people in it. but then there's a number of others. The labs I interface with acidity test that can a very close collaborator of mine. Cindy is in biomedical engineering. She probably has eight people in her lab. And, and then we have a bunch of other people. We have mechanical engineers, Frank Gillespie. Who's part of it. in exercise physiology, Deanna Gates has been working real closely with us. So we have a lot of different labs, but I think he to success for the kinds of things that you want to make a big splash.
It's about putting a good team together and making sure that everyone does that thing that they're really good at. and everyone shares in the limelight. Everyone has an opportunity to publish, present grants, all that stuff. And no one is too selfish about anything. And I think we have such an amazing team and that's why things have gone so well.
So many people doing so much good work. 
Dr. Salvatore Pacella: [00:30:16] Yeah. How did you, how did this become an area of interest for you? obviously you had, some, your undergraduate training was in biomedical engineering. Obviously you got some interest in that, but how did you do, get into this as a plastic surgeon?
Dr. Paul Cederna: [00:30:30] Yeah. So I don't even know something you might have remembered, but I had this patient that he was moving an aluminum ladder, moving aluminum ladder on a wet day. And the aluminum ladder had an arc from a high voltage line and he got electrified. You had a 50% total body surface area burn. He was a national level power there, and he had burned his arm off.
And, I had operated on him, I don't know, 10, 11, 12 times. And he was, that guy would tell me every time I saw him all the struggles that he was having with his life and doing all the things. And I'm like, at that point, I'm like, I gotta work on this. I gotta figure out a way to. To get him something better than what's out there.
And, and he sent his become, I'm just at close, a close friend of mine, even though he's a big Michigan state fan, he's still become, he's such an inspiration to me and the guy's amazing, but that was really one of those moments for me that said, I got to work on this thing cause I got to make this better.
If I can. 
Dr. Sam Rhee: [00:31:35] It's pretty amazing. We've known you for a really long time. And to see you come to this part of your career where we've seen other, like a Sam says other people have become chairman, we see what they're like. They're very different from what you are. 
it's pretty crazy. I don't know you guys.
I remember one of my first earliest memories of Paul was sitting in the, or, and. Limp biscuit came on, nookie and wowed. The nurses were like, Please, could you turn this down? And he actually did not turn it down. He left it on as loud as possible. And it was, that style was emblematic of what you did back then.
And I actually, I hope you still do at this point. 
Dr. Paul Cederna: [00:32:22] Yeah. 
Dr. Salvatore Pacella: [00:32:23] A true bro. He's a true bro. 
Dr. Paul Cederna: [00:32:27] the reality is the world is full of really smart people. And I love what I do and I work really hard at what I do, and I love doing it that way, but I'm not going to do anything differently for sure.
I'm not going to change. I'm not going to be a different person. And so I think some of the, I'm small town guy from the upper peninsula, Michigan, not a particularly strong reader. not a particularly elastic guy. 
Dr. Salvatore Pacella: [00:32:53] You clearly did not go to the, Derek Zoolander school of kids that 
Dr. Paul Cederna: [00:32:57] can't read.
Good. I know, I'm not, as, I'm not a silver spoon kid, I'm not a private school kid. I'm, I'm none of those things in, and so I'm still pretty much the same. The same as I've always been. I just work really hard, and been lucky and had good people around me. And I think some of the leadership roles I've gotten, I think I get that because it's a little refreshing, cause I'm just different.
And, and that limp biscuit moment, I am sure that happened a lot because the era we lived in, lincoln park and other stuff back then. 
Dr. Salvatore Pacella: [00:33:32] Paul, we're just about running out of time, but I got one last question for you, obviously. you're a high functioning individual. You're incredibly successful. you deliver, value. but you're incredibly busy. I know you personally is having a lot of other interests outside of medicine, as a skier, a cyclist, a, boater.
So tell us what, how do you get it all done? How do how do you balance all this? 
Dr. Paul Cederna: [00:33:57] Yeah. So from, I got to tell you for me 
Dr. Salvatore Pacella: [00:34:00] a player, 
Dr. Paul Cederna: [00:34:01] a hockey player. Yeah. For me, it's about efficiency. It's about efficiency. So I get something in front of me and I am so focused on that thing and getting that thing done.
And then when I'm done with it, I don't linger over it. Then I move on and get something else done. So I'm just really efficient, the thing is. For a long time, I was able to get more done just by shrinking the amount of time I slept. But at some time, at some point,
then at that point, what you do is you have to start building teams around you, teams of people that you trust, that you believe in, you empowered to do things. And then as you build that around you, then you can have people working with you alongside of you arm and arm, getting more things done. And, so I don't waste a lot of time.
I don't hang around a lot doing anything. And so if I get home and I'm going to get some exercise, I change and I go get my exercise. I go really hard. And then when I'm done, if I need to get some stuff done back on my computer, I'm back on my computer. Totally fine on it, getting stuff done, but it's always about, it's always about compartmentalizing.
Being super efficient building teams around you in all aspects. So like from a leadership standpoint for the section, I have so many great people that I work with that are so much better than me. And I just have to have touch points with them once a day, something like that. and then they keep getting huge amounts of stuff done in the lab.
I have a bunch of incredibly talented people. Steve Kemp is a PhD that I work with closely in the lab. He has that army of people in the lab. Going all the time. He and I touched base every day, but not for that long. and so I really think it's all about that. it is easy. I gotta tell you.
So for me all in all the time, all in, all the time on everything I do there is there's no half-ass in it. So if I'm doing it. I'm all in on it. And 
Dr. Sam Rhee: [00:35:54] so then where do you see yourself going with this? You're now chairman, you have all this stuff going on. So five years, 10 years, or how long do you stayed with what you're doing 
Dr. Paul Cederna: [00:36:03] as long as I love it. So I'll tell you, I think at some point I'll let the chairman role go. because I think, there's younger people, it'd be a great experience for younger people to take over that part of it. And then I would focus back on, more time on my research. More time on teaching, more time on operating more time, water skiing, right now from a week ago.
Dr. Salvatore Pacella: [00:36:27] Paul. It's, it's really been fantastic. we'll have to have you out here in San Diego again and get another surf session. He was out here in February and we, we killed it. It was great. Paul, once again, thank you for joining us a true honor to have you on the podcast here. And, gentlemen, we will sign off, Huh? Thank you so much. Go Blue!